CMS Price Transparency Data

Culture, blood

Facility: Othello Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $153
Cash Discount Price: $144
vs. Medicare Baseline: 14.83x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Othello Community Hospital is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 14.83x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$153

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $144 (1395%)

Insurance Median: $153 (1483%)

Cash: $144 (1395% of Medicare)

Ins. Median: $153 (1483% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1483% of the Medicare baseline (a markup of 1383%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Ambetter / Centene	$82	795%
Amerigroup Mcaid	$82	795%
Chp - All Other Plans	$82	795%
Chp Mcaid	$82	795%
Cocare - All Plans	$82	795%
Gau - All Plans	$82	795%
Kaiser - All Plans	$82	795%
Molina - All Other Plans	$82	795%
Molina Mcaid	$82	795%
UnitedHealthcare	$82 - $192	795%
Medicare (plans)	$96	930%
Tricare	$125	1211%
Triwest - All Plans	$125	1211%
Asuris - All Plans	$153	1483%
Commercial Other - All Plans	$153	1483%
Hma - All Plans	$153	1483%
Hmso - All Plans	$153	1483%
Tpsc - All Plans	$153	1483%
Travelers - All Plans	$153	1483%
Veterans Admin - All Plans	$153	1483%
Blue Cross Blue Shield	$161	1560%
Cigna	$171	1657%
First Choice - All Plans	$173	1676%
Aetna	$180	1744%
Chp Mcr Adv	$192	1860%
Health Alliance Mcr Adv - All Plans	$192	1860%
Humana	$192	1860%
Molina Mcare	$192	1860%
Wellcare Mcr Adv - All Plans	$192	1860%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $144.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Othello Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87040.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.